Charge Edits Specialist II is responsible for reviewing and performing appropriate actions on charges and claims. This position is the point person within the department responsible for making all charge and claim correctio
Analyze charge review rules that require review.
Execute edits within charge review to achieve account resolution.
Generate reports to monitor the types of errors and their frequency.
Research accounts and request any needed supporting documentation.
Resolve all correction requests accurately and in a timely approach.
Responsible for performing edits on high dollar accounts.
Scope of responsibility may include utilizing reports to monitor volumes and overall success rates. Act as a point of escalation and monitor supervisory or secondary work queues.
High school graduate or GED certificate is required.
A minimum of 1 year experience in a physician billing or third party payer environment.
Candidate must demonstrate working knowledge of contracts, insurance benefits, exclusions and other billing requirements as well as claim forms, HMOs, PPOs, Medicare, Medicaid and compliance program regulations.
Candidate must demonstrate the ability to understand and navigate the payer adjudication process.
Candidate must demonstrate a strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations. Including the ability to diffuse complex situations in a calm and professional manner.
Must demonstrate effective communication skills both verbally and written.
Ability to multi-task, prioritize, and manage time effectively.
Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
Ability to work independently.
The ideal candidate is a motivated individual with a positive attitude and exceptional work ethic.